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6R9LP75LMP Increasing Access to Metabolic and Bariatric Surgery Programs for Adolescents
No full textLisa Baro Tower Health; Vesta Salehi Tower Health/Drexel University; Renee Riddle Tower Health; John Fam; Aaron Hechtman Tower Health; Stephan Myers Tower Health / Drexel University Introduction: [A robust adolescent metabolic and bariatric surgery (MBS) program was developed at The Reading Hospital. Adolescents are referred following the development of two of the largest multidisciplinary pediatric and adolescent weight management programs in the Commonwealth of Pennsylvania: (1) The Reading Hospital Weight Loss Surgery and Wellness Center in Wyomissing, Pa and (2) St. Christopher’s Hospital for Children Healthy Kids, Healthy Teens Program in Philadelphia. This arrangement brings a diverse adolescent population to our surgical practice.] Method: [We reviewed the MBSAQIP Registry Data on 126 MBS operations performed at Reading Hospital between August 20, 2020 and December 31, 2024 on adolescents age 15 to 19. All procedures were performed laparoscopically and included 124 gastric sleeves, 1 gastric bypass, and 1 conversion from a gastric sleeve to a single anastomosis duodenal switch. Data collected included demographics including race, weight loss, change in BMI, co-morbid conditions, surgical complications.] Results: [Review of our data has shown dramatic results with an average weight loss of 100 pounds and a decrease in BMI of 16 at one year following surgery. This was a diverse population including 58% Hispanic, 19% Black, and 15% White. Resolution: diabetes 93.3%, hypertension 91% and obstructive sleep apnea 95%. There was no mortality, leaks, transfusions or return to the operating room. Three patients required hydration, 3 were seen in the ED for abdominal pain or minor incisional bleeding and discharged and 2 were admitted for vitamin B1 deficiency. ] Conclusion: [Building new multidisciplinary pediatric and adolescent weight management programs is an effective strategy to increase access to MBS in adolescents. MBS is safe and effective in a diverse population
Immune Checkpoint Inhibitor (ICI)-Induced Painful Thyroiditis: A Rare Presentation With Thyrotoxicosis
No full textDescription: Thyroid dysfunction occurs in 5% to 15% of patients undergoing Immune Checkpoint Inhibitor (ICI) therapy, such as pembrolizumab, typically presenting as painless thyroiditis followed by hypothyroidism. Although often mild and manageable, rare cases of painful thyroiditis with overt thyrotoxicosis can arise, potentially complicating treatment. Case Report: A 23-year-old female with breast cancer treated with pembrolizumab presented with 6 days of fever, chills, erythema, and tenderness at a port site. Despite port removal and antibiotics, fevers persisted with tachycardia. An infectious workup and repeat were negative. Thyrotoxicosis was identified; TSH \u3c 0.008 mIU/L (0.35-4.94), free T4 3.23 ng/dL (0.70-1.48); thyroid tenderness and elevated ESR, consistent with thyroiditis. Free T3 was normal. Thyroid ultrasound showed diffuse gland enlargement. Initial treatment with prednisone, methimazole, and propranolol improved symptoms. After a contrast CT, fever and odynophagia worsened, managed with IV dexamethasone and increased methimazole. At discharge, she remained thyrotoxic; however, fever subsided. Endocrinology follow-up was arranged. Discussion: ICI-mediated thyroiditis, seen in cancer patients undergoing immunotherapy, typically begins with a thyrotoxic phase, often asymptomatic, and transitions rapidly to likely permanent hypothyroidism. Unlike other thyroiditis etiologies, it is not included in hyperthyroidism or thyrotoxicosis guidelines, necessitating a tailored approach. Painless thyroiditis from ICIs usually involves transient thyrotoxicosis in 5% to 20% of cases, followed by hypothyroidism lasting about 6 months, with most recovering normal function, though 10% to 20% develop permanent hypothyroidism. Unlike subacute or postpartum thyroiditis, ICI-mediated thyroiditis is painless, transitions faster (3 months vs 6-9 months), and may involve elevated TPO or thyroglobulin antibodies. Conclusion: This case emphasizes the importance of recognizing atypical patterns in ICI-mediated thyroiditis to ensure timely and appropriate intervention. The requirement for high-dose IV steroids and escalating thionamide doses highlights the severity of the condition, deviating from the usual mild and transient course of ICI-related thyroid dysfunction. This further underscores the need for close monitoring of thyroid function in patients undergoing immunotherapy to prevent complications such as thyroid storm. Guidelines recommend checking thyroid function tests every 4-6 weeks from therapy initiation and every 2-3 weeks after a thyroiditis diagnosis to detect hypothyroid conversion
Gender Disparities, Temporal Trends and Cardiovascular Outcomes in Patients with Angina Undergoing SPECT Stress Test
No full textIntroduction: Disparities in the use of imaging modalities like SPECT stress testing may impact outcomes across patient groups. This study assessed gender-based differences in SPECT use and cardiovascular outcomes in angina patients. Methods: This retrospective cohort study used real-world data from 55 healthcare organizations via the TriNetX Global Health Research Collaborative Network. Adults (\u3e18 years) diagnosed with angina between April 2015 and April 2025 were included. Patients with prior coronary artery disease or incomplete data were excluded. Gender-based subcohorts were created. Propensity score matching adjusted for demographic and clinical factors. Kaplan-Meier survival analyses, log-rank tests, and Cox proportional hazards models compared outcomes. Primary outcomes were SPECT stress test utilization and a composite of myocardial infarction and ischemic cardiomyopathy. Treatment pathways mapped diagnostic and therapeutic decisions. Results: A total of 1,683,492 patients were included. Of these, 66.8% of males and 67.9% of females underwent SPECT stress testing (HR 0.96; 95% CI: 0.95-0.97; p\u3c 0.0001), with consistent yearly trends. After angina diagnosis, the most frequent tests were SPECT with treadmill (47.3%), treadmill alone (27.4%), and coronary angiography (16%). These proportions were consistent across gender subgroups. Males had a significantly higher incidence of the composite outcome of myocardial infarction and ischemic cardiomyopathy (HR 1.28; 95% CI: 1.25-1.31; p\u3c 0.0001). Discussion: SPECT with treadmill stress testing was the most common used diagnostic tool following angina diagnosis. There was slightly lower use among males with higher incidence of adverse outcomes. These findings highlight the importance of equitable diagnostic strategies and support further research into sex-specific care pathways for angina management. [Formula presented
From Parkinsonism to Hydrocephalus: Unraveling a Complex Diagnosis
No full textObjective: To report a case of obstructive hydrocephalus masquerading as Parkinson\u27s disease (PD). Background: Parkinson\u27s disease affects over 1% of those over 60 and can be either idiopathic or secondary, impacting treatment and prognosis. Its overlapping features with obstructive hydrocephalus complicate diagnosis, highlighting the importance of imaging in cases with ambiguous presentations to improve outcomes. Design/Methods: Case report Results: A 62-year-old male who worked at lead battery company, with no significant history, presented to neurology clinic for bilateral leg weakness and heaviness and difficulty initiating walk causing falls for past 6 months. Wife reported memory issues, but patient was independent with activities of daily living. Initial exam showed bradykinesia, masked facies, diffuse hyperreflexia, reduced arm swing, and en bloc turning with no cogwheel rigidity. MoCA score was 21/30 with points lost on visuospatial, abstraction, and delayed recall. He met criteria for Parkinson\u27s disease and was started on Sinemet trial. Labs showed RPR, TSH, Vitamin B12, MMA, vitamin B1, folate, copper, and lead within normal limits. MRI Brain showed severe stenosis of inferior cerebral aqueduct and dilation of proximal ventricular system with transependymal flow. MRI Cervical spine done for diffuse hyperreflexia showed mild central spinal stenosis at level of C4-C5. He continued to have falls and underwent ventriculoperitoneal shunt placement. Subsequent CT head showed substantially decreased hydrocephalus. Patient\u27s gait improved significantly with persistent mildly reduced arm swing and en bloc turning and his MoCA improved to 27/30. Sinemet was gradually tapered and eventually discontinued. Conclusions: Parkinsonism can be secondary to hydrocephalus, complicating differentiation from idiopathic Parkinson\u27s disease. Ourpatient had inferior aqueductal stenosis and periaqueductal edema, affecting medial substantia nigra projections andmimicking Parkinson\u27s symptoms. Despite meeting UKPDSBB criteria with bradykinesia and postural instability, unresponsiveness to dopaminergic treatment and falls within three years raises suspicion for an alternate pathology
Relation of Migraine to Stroke Risk in Postmenopausal Women: Findings from the Women\u27s Health Initiative
No full textIntroduction: Migraines are a known risk factor for stroke among reproductive-aged women, though the relation of migraines to stroke risk among postmenopausal women remains unclear. We assessed the association between a history of diagnosed migraine and incident stroke among postmenopausal women and investigated age differences in the association. Methods: We included women enrolled in the Women\u27s Health Initiative (WHI), a large longitudinal cohort study of postmenopausal women in the U.S. We excluded women with a history of stroke or TIA at baseline or with missing data on history of migraine or key covariates. The primary exposure was a history at baseline of self-reported migraine diagnosed by a physician. The primary outcome was incident stroke (total, ischemic [IS], or hemorrhagic [ICH]). Multivariable Cox proportional hazards models were used to test the cause-specific hazard ratios (HRs) between migraine history and total stroke, IS (overall and by subtype), and ICH, sequentially adjusted for age and traditional and female-specific risk factors. Using multivariable Cox proportional hazard models, we then quantified the association between migraine history and total stroke by age in 5-year groups at baseline. Results: 130,277 participants were included. The median age at baseline was 61 years (IQR 56-67 years) for those with a migraine history compared to 63 years (IQR 57-69 years) for those without. Overall, 5,743 strokes occurred over a median follow-up period of 19.9 years (IQR 9.1-25). In multivariable-adjusted models (Table), there was a marginal association between migraine history and total stroke (HR=1.07; 95% CI, 0.99-1.17) and a significant association between migraine history and IS (HR=1.12; 95% CI, 1.02-1.23), most pronounced in the cardioembolic category. Migraine was not associated with risk of ICH (HR=0.85, 95%CI, 0.67-1.09). Risk appears to be of greatest magnitude in early (HR 1.26, 95% 0.93-1.72) and late (HR 1.16, 95%CI 0.89-1.50) postmenopausal years (Figure), though the differences by age group were not statistically significant. Conclusions: Over a 20-year follow-up period, postmenopausal women with self-reported histories of migraine had a higher risk of IS, but not total or ICH, suggesting that migraine history contributes to ischemic stroke risk during the postmenopausal years. Along with other known risk factors, migraine history should be considered in stroke risk factor screening and prevention efforts after menopause
Geographic disparities in access to gynecologic oncologist subspecialty care
No full textObjectives: Although advancements have been made in the treatment of gynecologic malignancies, health disparities persist, preventing equal access to treatment. Unequal cancer burden is endured by patients of lower socioeconomic status, racial minorities and those living in geographical areas remote from subspecialty care. Survival disparities have been observed in several studies and attributed to differences in regional socioeconomic factors and access to treatment and post-treatment follow-up. Little has been formally studied on census data about the distribution of the gynecologic oncology workforce. This study aimed to define the geographic distribution of the gynecologic oncology workforce compared to the general population. The secondary aim was to define the differences in access to general obstetrician/gynecologist (OB/GYN) care versus subspecialty care. Identifying geographic regions with limited access to gynecologic oncology specialists may aid in efforts to improve disparities in gynecologic cancer care. Methods: OB/GYN generalists practicing in the United States (U.S.) were tabulated using 2021 Association of American Medical Colleges (AAMC) physician workforce profile data. Gynecologic oncologists (GOs) practicing in the U.S. were identified using the National Plan and Provider Enumeration System (NPPES) registry using specialty taxonomy codes. Physician location was determined by zip code listed in the NPPES registry. U.S. Census data was queried to estimate the female population by state (based on the 2020 U.S. Census). The relationships between OB/GYN generalists, GOs and the U.S. female population were calculated. The density of OB/GYN generalists and GOs per 100,000 females was geographically mapped (Fig. 1). Results: A total of 42,889 OB/GYN generalists and 2284 gynecologic oncology subspecialists were identified. All 50 states and two U.S. territories had at least some generalist OB/GYN physicians. North Dakota and Wyoming lacked any GOs. Across 50 states and two U.S. territories, there was a median of 24.1 OB/GYN generalists and 1.33 GOs per 100,000 females. The District of Columbia had the highest density of generalists, with 69.4 per 100,000 females. Comparatively, Arizona had the lowest density of generalists at 7.48 per 100,000 females. District of Columbia had the highest density of GOs, with 3.92 per 100,000 females. In contrast, Puerto Rico had the lowest density of subspecialists, after North Dakota and Wyoming, at 0.47 per 100,000 females. There was significantly greater geographic clustering among subspecialists than generalists. Conclusions: Geographic disparities in access to GOs compared to general OB/GYN are identified in this study, highlighting inequities in specialized care in the U.S. Unlike generalist care, which is more widely available, GOs are often concentrated in urban or well-resourced areas, leaving rural and underserved patients at a disadvantage. This gap in access leads to delayed diagnoses, suboptimal treatments and poorer outcomes for patients. Addressing these disparities is essential to ensuring equitable health care, improving survival rates and enhancing the quality of life for patients across diverse regions. Policy interventions, resource reallocation and improvements in health care infrastructure are required to mitigate these inequities to ensure that all women, regardless of location or social determinants, receive timely and specialized care. [Formula presented
Evaluating human-in-the-loop strategies for artificial intelligence-enabled translation of patient discharge instructions: a multidisciplinary analysis.
No full textMachine translation supported by artificial intelligence (AI) may enhance linguistically-concordant care for patients speaking languages other than English. This assessment of free-text inpatient discharge instructions in Arabic, Armenian, Bengali, simplified Chinese, Somali, and Spanish compared linguist, clinician, and family caregiver evaluations of translations generated by (1) ChatGPT-4o, (2) professional linguists, and (3) human-in-the-loop (AI-generated, professional linguist post-edited). Likert scales (1-5; higher is better) evaluated linguistic and clinical characteristics of each translation. ChatGPT-4o exhibited variable performance relative to professional translations, with poorest ratings for digitally underrepresented languages (Armenian and Somali). Conversely, human-in-the-loop translations achieved comparable, often better, outcomes to professional translations for all languages, (e.g., Armenian mean overall quality: 3.9 [95% CI 3.7-4.2] vs. professional 3.6 [3.4-3.9], p = 0.01), were most frequently preferred (46.5% vs. 28.4%) and had shorter mean translation time (7.1 [5.4-8.8] vs. 16.8 [13.7-19.9] min, p \u3c 0.001). Human-in-the-loop strategies may enable safe, efficient, equitable machine translation application in clinical practice
TCT-909 Comparative Effectiveness of Laser Versus Shockwave Intravascular Lithotripsy for Calcified Coronary and Peripheral Artery Lesions: A Systematic Review and Meta-Analysis
No full textBackground: Severe vascular calcification in coronary and peripheral arteries remains a major challenge for endovascular therapy. Intravascular lithotripsy (IVL), using either laser or shockwave energy, has emerged as a novel solution for plaque modification. Our objective was to compare the safety and efficacy of laser IVL versus shockwave IVL in the treatment of heavily calcified lesions in both coronary and peripheral arterial territories, including analysis of patient demographics, clinical outcomes, and modality-specific strengths and limitations. Methods: A systematic review and meta-analysis of 18 studies (5,302 patients) comparing laser IVL and shockwave IVL was performed. Outcomes assessed included procedural success, device success, acute lumen gain, target lesion revascularization (TLR), and major adverse events (MAEs). Subgroup analyses by arterial territory (coronary vs peripheral) and patient demographics were performed. Results: Of 5,302 patients (mean age 69 ± 9 years, 62% male, 42% diabetic, 36% with chronic kidney disease [CKD]), 2,418 underwent laser IVL and 2,884 underwent shockwave IVL. Shockwave IVL showed higher device success in coronary arteries (98.3% vs 92.1%, p\u3c 0.001) and fewer procedural complications (p=0.02). In peripheral arteries, laser IVL had greater acute lumen gain (3.1 mm vs 2.6 mm, p=0.01) and lower bailout stenting rates (p=0.04). TLR rates at 12 months were lower in shockwave IVL in coronary lesions (8.6% vs 12.4%, p=0.03), but similar in peripheral lesions. Conclusion: Shockwave IVL demonstrates superior safety and device success in coronary interventions, while laser IVL shows benefits in plaque debulking and lumen gain in peripheral arteries. Device selection should be tailored to vascular bed, lesion morphology, and patient-specific factors. Categories: CORONARY: Coronary Atherectomy, Plaque Modification, Lithotripsy, Thrombectomy, Cutting/Scoring Balloon
TCT-1202 Impact of Emergency Physician-Performed Point-of-Care Echocardiography in Acute Coronary Syndrome Presentations: Long-Term Clinical Outcomes
No full textBackground: Point-of-care echocardiography (POCUS) performed by emergency physicians is increasingly utilized for early risk stratification in acute coronary syndrome (ACS). However, the impact of early POCUS use on long-term outcomes remains poorly defined. This study evaluates whether routine use of POCUS in the emergency department (ED) for ACS patients improves long-term cardiovascular outcomes compared to standard evaluation without POCUS. Methods: We conducted a prospective, multicenter cohort study including 3,720 ACS patients presenting to the ED across 12 institutions. Patients were stratified into two groups: those who received POCUS by trained emergency physicians during the initial ER evaluation (n=1,864) and those who underwent standard clinical assessment without POCUS (n=1,856). The primary endpoint was incidence of major adverse cardiovascular events (MACE) at 12 months. Secondary endpoints included time to diagnosis, in-hospital mortality, need for advanced mechanical support, and 30-day readmission. Results: Patients in the POCUS group had significantly lower rates of MACE at 12 months (11.8% vs 15.4%, p=0.003), in-hospital mortality (2.2% vs 3.6%, p=0.02), and need for mechanical circulatory support (2.5% vs 4.1%, p=0.01) compared to the control group. The median time to confirmed diagnosis was also shorter in the POCUS group (41 min vs 63 min, p\u3c 0.001), suggesting earlier triage and more appropriate risk stratification. There was a modest but significant reduction in 30-day readmission (6.5% vs 8.2%, p=0.04). Conclusion: Emergency physician-performed point-of-care echocardiography (POCUS) in patients presenting with acute coronary syndrome significantly improves long-term clinical outcomes, including reduced rates of MACE, in-hospital mortality, and mechanical circulatory support utilization. Additionally, POCUS use is associated with faster diagnosis and reduced early readmission rates. These findings support the integration of POCUS into routine emergency department evaluation of ACS patients as a valuable tool for early risk stratification and timely clinical decision-making. Categories: CORONARY: Acute Coronary Syndrome
TCT-801 Comparative Efficacy and Safety of Beta Blockers Versus SGLT2 Inhibitors in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries (MINOCA)
No full textBackground: MINOCA represents a distinct clinical entity of acute myocardial infarction without obstructive coronary artery disease, posing challenges in therapeutic strategies. While beta blockers are commonly prescribed post-MI, the cardiometabolic and endothelial benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) offer a novel therapeutic potential in this population. We compared the clinical outcomes of beta blocker therapy versus SGLT2 inhibitor therapy in patients with MINOCA. Methods: This retrospective, multicenter cohort study analyzed 842 patients diagnosed with MINOCA between 2018–2023. Patients were grouped based on discharge medications: beta blockers (BB group, n=416) or SGLT2 inhibitors (SGLT2i group, n=426). The primary endpoint was the composite of cardiovascular death, heart failure hospitalization, or recurrent MI at 12 months. Secondary endpoints included all-cause mortality, stroke, new-onset heart failure, and left ventricular ejection fraction (LVEF) improvement. Propensity score matching was used (1:1), resulting in 342 matched pairs. Results: At 12 months, the primary composite endpoint occurred in 12.6% of the SGLT2i group versus 20.2% of the BB group (p=0.007). SGLT2i were associated with lower rates of heart failure hospitalization (4.1% vs. 9.4%, p=0.003) and greater LVEF improvement (+8.2% vs. +3.5%, p\u3c 0.001). No significant differences were observed in recurrent MI (4.7% vs. 6.1%, p=0.39) or stroke (1.8% vs. 2.3%, p=0.62). All-cause mortality was lower in the SGLT2i group (3.8% vs. 7.3%, p=0.03). Conclusion: In patients with MINOCA, SGLT2 inhibitors were associated with improved cardiovascular outcomes compared to beta blockers, particularly in reducing heart failure-related events and enhancing cardiac function. Categories: CORONARY: Pharmacology/Pharmacotherap